1. Ulcerative Colitis (effects only the COLON) 2. Crohn's disease (any part of GI tract mouth - anus)

1. Mucosal immune system exerts an inappropriate response to luminal antigens such as bacteria which may enter the mucosa via leaky epithelium

IBD Flashcards by Neil Srivastava

Name two IBDs

Ulcerative Colitis (effects only the COLON)

2. Crohn’s disease (any part of GI tract mouth - anus)

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What ethnic group are most vulnerable to IBD

Jewish people

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When does IBD occur

Mucosal immune system exerts an inappropriate response to luminal antigens such as bacteria which may enter the mucosa via leaky epithelium

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What is Ulcerative Colitis

Relapsing and remitting inflammatory disorder of COLONIC MUCOSA

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What is ulcerative colitis od the rectum called

Proctitis

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What is left-sided colitis

Rectum AND left colon

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What is pan colitis

Ulcerative colitis that effects the ENTIRE COLON (up to ileocaecal valve)

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Does ulcerative colitis effect ileocaecal valve

Never effects proximal to the ileocaecal valve

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Where is ulcerative colitis most common

N. Europe
UK
N. A

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Is Crohn’s or Colitis more common

Coeliac’s

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What gender do ulcerative colitis effect

Males + females equally

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What kind of habits can increase chances of colitis

SMOKERS and EX SMOKERS

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Chances of ulcerative colitis with first degree relative having the disease

1 in 6

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What surgery seems to protect people from ulcerative colitis

Appendicectomy before age 20

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Risk factors of ulcerative colitis

Family History
NSAIDs
Chronic stress + depression triggers flares

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What differentiates Ulcerative Colitis from Crohn’s

Restricted mucosal disease

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What part of the colon does ulcerative colitis effect

Begins in the rectum and extends (only up to the ileocaecal valve)

Circumferential and continuous inflammation (NO SKIP LESIONS)

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Appearance of mucosa in ulcerative colitis

Reddened and inflamed + bleeds easily

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What structures are seen in severe ulcerative colitis

Ulcers and pseudo-polyps

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Extent of spread of inflammation in ulcerative colitis

Inflammation stays in mucosal layer
No Granulomata
Increased crypt abscesses

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What happens to goblet cells in colitis

Depleted goblet cells

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Clinical presentations in severe ulcerative colitis

Runs a course of remissions and exacerbations
Restricted pain in lower left quadrant
Episodic or chronic diarrhoea with blood or mucus
Cramps
Bowel frequency linked to severity

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Symptoms seen in acute UC

Fever
Tachycardia
Tender distended abdomen

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In acute attacks of UC what is seen

Bloody diarrhoea at night

Incontinence

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What are extra-intestinal signs of Ulcerative Colitis

1. Clubbing 2. Aphthous oral ulcers 3. Erythema nodusum 4. Amyloidosis

What is erythema nodusum

Red round lumps below skin surface

Complications of Ulcerative Colitis

LIVER: 1. fatty change 2. Chronic pericholangitis 3. Sclerosing cholangitis COLON: 1. Blood loss 2. Perforation 3. Toxic dilatation 4. Colorectal cancer Skin: Erythema nodusum Pyoderma gangrenous (painful ulcers on the skin ) Joints: Ankylosing spondylitis Arthritis EYES: Iritis Uveitis Episcleritis

Differential diagnosis of UC

Other causes of diarrhoea (salmonella, giardia intestinal and rotavirus)

Blood tests in UC

1. WCC and planets raise din severe attacks 2. Iron deficiency anaemia 3. ESR and CRP raised 4. Liver biochemistry abnormal 5. Hypoalbuminaemia 6. pANCA (Anti-neutrophilic cytoplasmic antibody) = positive NEGATIVE in crown's

Other than blood tests, how else do we diagnose UC

1. Stool samples 2. Faecal cal protein 3. Colonoscopy (GOLD STANDARD) with mucosal biopsy 4. AXR

Why are stool samples taken for UC

Exclude C.diff and campylobacter

What does the presence of faecal cal protein suggest

IBD (not specific)

Role of colonoscopy with mucosal biopsy for UC

1. Allows assessment of disease activity and extent | 2. Can see inflammatory infiltrate, goblet cell depletion, crypt abscesses and mucosal ulcers

What would an AXR show for UC

1. Exclude colonic dilatation in acute severe attacks

When is an AXR used for UC

If too severe for colonoscopy

How is UC treated

INDUCE REMISSION | 1. Aminosalicylate (5-ASA)

Where is 5-ASA absorbed

Small intestines

What 5-ASA is prescribed for UC

Sulfasalazine MESALAZINE OLSALAZINE

What is given for proctitis (mild UC)

Rectal 5-ASA

What is the first line treatment for left-sided colitis

Oral 5-ASA

If someone with UC does not response to 5-ASA what is prescribed instead

ORAL PREDNISOLON (glucocorticoid)

What is given in severe UC

ORAL PREDNISOLONE

In severe systemic involvement of UC, what is given (liver, skin and eye involvement)

1. HYDROCORTISONE 2. CICLOSPORIN 3. INFLIXIMAB

How do we maintain remission

5-ASA: most patients require maintenance treatment AZATHIOPRINE - for those who relapse if 5-ASA does not work

When is surgery done for UC

1. Indicated for severe colitis that fails to respond to treatment

What two surges are done for UC

1. Colectomy (colon removed) or ileoanal anastomosis (rectum fused to ileum)

What is the terminal ileum used for following ileoanal anastomosis

Reservoir pouch to store faeces

What is panproctocolectomy with ileostomy

Whole colon and rectum are removed and ileum is brought out to abdominal wall as a stoma

What is Crohn's disease

A chronic inflammatory GI disease characterised by transmural (goes deep into mucosa) granulomatous inflammation affecting any part of the gut from mouth to anus (especially in terminal ileum and proximal colon)

Difference between Crohn's disease and UC

1. Skip lesions found in CD (unaffected bowel between areas of active disease)

Where is prevalence for Crohn's highest

1. N. Europe 2. UK 3. North America

What gender does Crohn's effect more

Females

What risk factors are there for corhn's

1. Smoking 2. 1 in 5 chance if first-degree relative 3. NSAIDs 4. Family History 5. Chronic stress and depression triggers flares 6. Good hygiene (those who live in poor hygiene families have lower risk of developing CD) 7. Appendicectomy may increase risk of CD development

Where does Crohn's typically effect

Terminal ileum and proximal colon

What happens to the wall of the bowel in Corhn's

Thickened and narrowed | Cobblestone appearance of mucosa due to ulcers and fissures

What layers of the bowel does inflammation extend into

ALL LAYERS of the bowel

What happens to cells in Crohn's

1. Increase in chronic inflammatory cells 2. Lymphoid hyperplasia 3. Granulomas (non-caseating epithelia cell aggregates with langerhand' giant cells) 4. Goblet cells present 5. Less crypt abscesses than UC

Clinical presentation of Corhn's

1. Diarrhoea with urgency (need to go 5-6 times in 45 mins), bleeding and pain 2. Abdo pain (mimicks appendicitis - right iliac fossa pain) 3. Weight loss 4. Malaise 5. Lethargy 6. Anorexia 7. Abdo tenderness 8. Perianal abscess 9. Anal strictures 10. Extra intestinal signs: aphthous oral ulcerations, clubbing, skin, joint and eye problems

Complications of Crohn's

1. Perforation and BLEEDING - major 2. Fistula formation 3. Anal: skin tags, fissures, fistula 4. Malabsorption 5. Small bowel obstruction 6. Toxic dilatation of colon 7. Colorectal cancer 8. venous thrombosis 9. Amyloidosis

Differential diagnosis of Crohn's

1. Alternative causes of diarrhoea should be excluded (Salmonella, Giardia intestinal and rotavirus) 2. Chronic diarrhoea

Physical examination of Crohn's

1. Tenderness of right iliac fossa | 2. Anal examination

Blood tests in Crohn's

1. Anaemia is common due to malabsorption and iron/folate deficiency 2. B12 anaemia is unusual 3. Raised ESR and CRP 4. Raised WBC and platelets 5. Hypoalbuminaemia present in severe disease as part of acute phase response to inflammation associated with raised CRp 6. Liver biochemistry may be abnormal 7. Negative pANCA

Other than blood tests what other diagnostic features of crohn's are there

1. Stool sample (exclude C.difficile and campylobacter) 2. Faecal cal protein (indicates IBD not specific) 3. Colonoscopy (confirms spot lesions and granulomatous transmural inflammation) 4. Upper GI endoscopy (exclude oesophageal and gasproduodenal disease)

How is Crohn's treated

1. Smoking cessation | 2. Anaemia due to iron/B12 or folate deficiency (replacement)

How is mild attacks of crown's traded

Controlled-release corticosteroids (BUDESONIDE)

How is moderate to severe tacks of crohn's treated

Glucocorticoids (ORAL PREDNISOLONE)

When do we reduce the dosage of ORAL PREDNISOLONE

Every 2-4 weeks if symptoms resolve

How is severe attacks of Crohn's treated

1. IV HYDROCORTISONE 2. Treat rectal disease (HYDROCORTISONE per rectum) 3. Antibiotics (IV METRONIDAZOLE) for perianal disease (inflammation at or near the anus) and abscesses 4. ORAL PREDNISOLONE if IV METRONIDAZOLE is working

how do we treat Corhn's disease if there is no improvement

Switch to anti-TNF antibodies (INFLIXIMAB or ADALIMUMAB)

How do INFLIXIMAB and ADALIMUMAB function

Reduce disease activity by countering neutrophil accumulation and granuloma formation and activating complement Causes cytotoxicity to CD4 cells clearing cells which drive the immune response

Main drugs that keep crohn's in remission

1. AZATHIOPRINE 2. METHOTREXATE (if intolerant to AZATHIOPRINE) 3. Anti-TNF antibodies (reduces remission if resistant to corticosteroids, immunosuppression then maintains it)

Main surgical intervention for crohn's

Temporary Ileostomy = Allows time for affected areas to rest

Worst case scenario surgical intervention for Crohn's

1. Resection (results in short bowel syndrome so diarrhoea and malabsorption)

Parts of the colon affect din Coeliac's, UC and Crohn's

1. Duodenum 2. Colon 3. ASS to mouth

Wat condition has no skip lesions

IBD Flashcards

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